|
HC HUMERUS
|
Facility
|
OP
|
$943.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
909001508
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$848.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.81
|
| Rate for Payer: Blue Distinction Transplant |
$565.80
|
| Rate for Payer: Blue Shield of California Commercial |
$582.77
|
| Rate for Payer: Blue Shield of California EPN |
$458.30
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Central Health Plan Commercial |
$754.40
|
| Rate for Payer: Cigna of CA HMO |
$603.52
|
| Rate for Payer: Cigna of CA PPO |
$697.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$801.55
|
| Rate for Payer: Global Benefits Group Commercial |
$565.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$848.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$707.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$707.25
|
| Rate for Payer: Networks By Design Commercial |
$612.95
|
| Rate for Payer: Prime Health Services Commercial |
$801.55
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$565.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$565.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC HUMERUS
|
Facility
|
IP
|
$943.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
909001508
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$188.60 |
| Max. Negotiated Rate |
$848.70 |
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Central Health Plan Commercial |
$754.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.20
|
| Rate for Payer: Galaxy Health WC |
$801.55
|
| Rate for Payer: Global Benefits Group Commercial |
$565.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$848.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.60
|
| Rate for Payer: Multiplan Commercial |
$707.25
|
| Rate for Payer: Networks By Design Commercial |
$612.95
|
| Rate for Payer: Prime Health Services Commercial |
$801.55
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$27.74 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$59.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$128.40
|
| Rate for Payer: Blue Shield of California Commercial |
$134.61
|
| Rate for Payer: Blue Shield of California EPN |
$104.65
|
| Rate for Payer: Caremore Medicare Advantage |
$59.35
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Central Health Plan Commercial |
$171.20
|
| Rate for Payer: Cigna of CA HMO |
$136.96
|
| Rate for Payer: Cigna of CA PPO |
$158.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$160.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: InnovAge PACE Commercial |
$89.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
| Rate for Payer: Prime Health Services Medicare |
$62.91
|
| Rate for Payer: Riverside University Health System MISP |
$65.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$128.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$128.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.00
|
| Rate for Payer: United Healthcare All Other HMO |
$107.00
|
| Rate for Payer: United Healthcare HMO Rider |
$107.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.74 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$59.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$103.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.43
|
| Rate for Payer: Blue Distinction Transplant |
$128.40
|
| Rate for Payer: Blue Shield of California Commercial |
$134.61
|
| Rate for Payer: Blue Shield of California EPN |
$104.65
|
| Rate for Payer: Caremore Medicare Advantage |
$59.35
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Central Health Plan Commercial |
$171.20
|
| Rate for Payer: Cigna of CA HMO |
$136.96
|
| Rate for Payer: Cigna of CA PPO |
$158.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$160.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: InnovAge PACE Commercial |
$89.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
| Rate for Payer: Prime Health Services Medicare |
$62.91
|
| Rate for Payer: Riverside University Health System MISP |
$65.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$128.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$128.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.00
|
| Rate for Payer: United Healthcare All Other HMO |
$107.00
|
| Rate for Payer: United Healthcare HMO Rider |
$107.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.80 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Central Health Plan Commercial |
$171.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.60
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.80
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$42.80 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Central Health Plan Commercial |
$171.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.60
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.80
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$42.80 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Central Health Plan Commercial |
$171.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.60
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.80
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.74 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$128.40
|
| Rate for Payer: Caremore Medicare Advantage |
$59.35
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Central Health Plan Commercial |
$171.20
|
| Rate for Payer: Cigna of CA PPO |
$158.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$160.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: InnovAge PACE Commercial |
$89.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
| Rate for Payer: Prime Health Services Medicare |
$62.91
|
| Rate for Payer: Riverside University Health System MISP |
$65.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$128.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.00
|
| Rate for Payer: United Healthcare All Other HMO |
$107.00
|
| Rate for Payer: United Healthcare HMO Rider |
$107.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$42.80 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Central Health Plan Commercial |
$171.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.60
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.80
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$27.74 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$59.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$103.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.43
|
| Rate for Payer: Blue Distinction Transplant |
$128.40
|
| Rate for Payer: Caremore Medicare Advantage |
$59.35
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Central Health Plan Commercial |
$171.20
|
| Rate for Payer: Cigna of CA HMO |
$136.96
|
| Rate for Payer: Cigna of CA PPO |
$158.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$160.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: InnovAge PACE Commercial |
$89.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
| Rate for Payer: Prime Health Services Medicare |
$62.91
|
| Rate for Payer: Riverside University Health System MISP |
$65.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$128.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$228.20 |
| Max. Negotiated Rate |
$1,026.90 |
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Central Health Plan Commercial |
$912.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.40
|
| Rate for Payer: Galaxy Health WC |
$969.85
|
| Rate for Payer: Global Benefits Group Commercial |
$684.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,026.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$761.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$434.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.20
|
| Rate for Payer: Multiplan Commercial |
$855.75
|
| Rate for Payer: Networks By Design Commercial |
$741.65
|
| Rate for Payer: Prime Health Services Commercial |
$969.85
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$228.20 |
| Max. Negotiated Rate |
$1,026.90 |
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Central Health Plan Commercial |
$912.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.40
|
| Rate for Payer: Galaxy Health WC |
$969.85
|
| Rate for Payer: Global Benefits Group Commercial |
$684.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,026.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$761.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$434.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.20
|
| Rate for Payer: Multiplan Commercial |
$855.75
|
| Rate for Payer: Networks By Design Commercial |
$741.65
|
| Rate for Payer: Prime Health Services Commercial |
$969.85
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$228.20 |
| Max. Negotiated Rate |
$1,026.90 |
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Central Health Plan Commercial |
$912.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.40
|
| Rate for Payer: Galaxy Health WC |
$969.85
|
| Rate for Payer: Global Benefits Group Commercial |
$684.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,026.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$761.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$434.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.20
|
| Rate for Payer: Multiplan Commercial |
$855.75
|
| Rate for Payer: Networks By Design Commercial |
$741.65
|
| Rate for Payer: Prime Health Services Commercial |
$969.85
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$228.20 |
| Max. Negotiated Rate |
$1,026.90 |
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Central Health Plan Commercial |
$912.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.40
|
| Rate for Payer: Galaxy Health WC |
$969.85
|
| Rate for Payer: Global Benefits Group Commercial |
$684.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,026.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$761.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$434.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.20
|
| Rate for Payer: Multiplan Commercial |
$855.75
|
| Rate for Payer: Networks By Design Commercial |
$741.65
|
| Rate for Payer: Prime Health Services Commercial |
$969.85
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$97.47 |
| Max. Negotiated Rate |
$1,026.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$267.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$342.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$552.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$674.10
|
| Rate for Payer: Blue Distinction Transplant |
$684.60
|
| Rate for Payer: Caremore Medicare Advantage |
$267.80
|
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Central Health Plan Commercial |
$912.80
|
| Rate for Payer: Cigna of CA HMO |
$730.24
|
| Rate for Payer: Cigna of CA PPO |
$844.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$969.85
|
| Rate for Payer: Global Benefits Group Commercial |
$684.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,026.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$855.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: InnovAge PACE Commercial |
$401.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$761.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| Rate for Payer: Multiplan Commercial |
$855.75
|
| Rate for Payer: Networks By Design Commercial |
$741.65
|
| Rate for Payer: Prime Health Services Commercial |
$969.85
|
| Rate for Payer: Prime Health Services Medicare |
$283.87
|
| Rate for Payer: Riverside University Health System MISP |
$294.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$684.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$228.20 |
| Max. Negotiated Rate |
$1,026.90 |
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Central Health Plan Commercial |
$912.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.40
|
| Rate for Payer: Galaxy Health WC |
$969.85
|
| Rate for Payer: Global Benefits Group Commercial |
$684.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,026.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$761.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$434.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.20
|
| Rate for Payer: Multiplan Commercial |
$855.75
|
| Rate for Payer: Networks By Design Commercial |
$741.65
|
| Rate for Payer: Prime Health Services Commercial |
$969.85
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$97.47 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$267.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$342.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$552.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$674.10
|
| Rate for Payer: Blue Distinction Transplant |
$684.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$267.80
|
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Central Health Plan Commercial |
$912.80
|
| Rate for Payer: Cigna of CA HMO |
$730.24
|
| Rate for Payer: Cigna of CA PPO |
$844.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$969.85
|
| Rate for Payer: Global Benefits Group Commercial |
$684.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,026.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$855.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: InnovAge PACE Commercial |
$401.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$761.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| Rate for Payer: Multiplan Commercial |
$855.75
|
| Rate for Payer: Networks By Design Commercial |
$741.65
|
| Rate for Payer: Prime Health Services Commercial |
$969.85
|
| Rate for Payer: Prime Health Services Medicare |
$283.87
|
| Rate for Payer: Riverside University Health System MISP |
$294.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$684.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$684.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$97.47 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$684.60
|
| Rate for Payer: Caremore Medicare Advantage |
$267.80
|
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Central Health Plan Commercial |
$912.80
|
| Rate for Payer: Cigna of CA PPO |
$844.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$969.85
|
| Rate for Payer: Global Benefits Group Commercial |
$684.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,026.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$855.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: InnovAge PACE Commercial |
$401.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$761.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| Rate for Payer: Multiplan Commercial |
$855.75
|
| Rate for Payer: Networks By Design Commercial |
$741.65
|
| Rate for Payer: Prime Health Services Commercial |
$969.85
|
| Rate for Payer: Prime Health Services Medicare |
$283.87
|
| Rate for Payer: Riverside University Health System MISP |
$294.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$684.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$570.50
|
| Rate for Payer: United Healthcare All Other HMO |
$570.50
|
| Rate for Payer: United Healthcare HMO Rider |
$570.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$97.47 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$267.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$342.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$684.60
|
| Rate for Payer: Blue Shield of California Commercial |
$717.69
|
| Rate for Payer: Blue Shield of California EPN |
$557.95
|
| Rate for Payer: Caremore Medicare Advantage |
$267.80
|
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Central Health Plan Commercial |
$912.80
|
| Rate for Payer: Cigna of CA HMO |
$730.24
|
| Rate for Payer: Cigna of CA PPO |
$844.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$969.85
|
| Rate for Payer: Global Benefits Group Commercial |
$684.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,026.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$855.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: InnovAge PACE Commercial |
$401.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$761.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| Rate for Payer: Multiplan Commercial |
$855.75
|
| Rate for Payer: Networks By Design Commercial |
$741.65
|
| Rate for Payer: Prime Health Services Commercial |
$969.85
|
| Rate for Payer: Prime Health Services Medicare |
$283.87
|
| Rate for Payer: Riverside University Health System MISP |
$294.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$684.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$684.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$570.50
|
| Rate for Payer: United Healthcare All Other HMO |
$570.50
|
| Rate for Payer: United Healthcare HMO Rider |
$570.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.47 |
| Max. Negotiated Rate |
$1,026.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$267.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$342.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$552.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$674.10
|
| Rate for Payer: Blue Distinction Transplant |
$684.60
|
| Rate for Payer: Blue Shield of California Commercial |
$717.69
|
| Rate for Payer: Blue Shield of California EPN |
$557.95
|
| Rate for Payer: Caremore Medicare Advantage |
$267.80
|
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Central Health Plan Commercial |
$912.80
|
| Rate for Payer: Cigna of CA HMO |
$730.24
|
| Rate for Payer: Cigna of CA PPO |
$844.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$969.85
|
| Rate for Payer: Global Benefits Group Commercial |
$684.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,026.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$855.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: InnovAge PACE Commercial |
$401.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$761.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| Rate for Payer: Multiplan Commercial |
$855.75
|
| Rate for Payer: Networks By Design Commercial |
$741.65
|
| Rate for Payer: Prime Health Services Commercial |
$969.85
|
| Rate for Payer: Prime Health Services Medicare |
$283.87
|
| Rate for Payer: Riverside University Health System MISP |
$294.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$684.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$684.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$570.50
|
| Rate for Payer: United Healthcare All Other HMO |
$570.50
|
| Rate for Payer: United Healthcare HMO Rider |
$570.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC HYDRAULIC SWING MINI HI ACTVTY
|
Facility
|
OP
|
$3,863.00
|
|
|
Service Code
|
CPT L5826
|
| Hospital Charge Code |
905355826
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,352.05 |
| Max. Negotiated Rate |
$3,476.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,283.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,124.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,870.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,282.26
|
| Rate for Payer: Blue Distinction Transplant |
$2,317.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,897.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,101.47
|
| Rate for Payer: Cash Price |
$1,738.35
|
| Rate for Payer: Cash Price |
$1,738.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,090.40
|
| Rate for Payer: Cigna of CA HMO |
$2,704.10
|
| Rate for Payer: Cigna of CA PPO |
$2,704.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,283.55
|
| Rate for Payer: Dignity Health Media |
$3,283.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,283.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,545.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,545.20
|
| Rate for Payer: Galaxy Health WC |
$3,283.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,317.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,476.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,897.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,352.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,576.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,658.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,583.83
|
| Rate for Payer: Multiplan Commercial |
$2,897.25
|
| Rate for Payer: Networks By Design Commercial |
$1,931.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,283.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,545.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,317.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,317.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,931.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,931.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,931.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,931.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,283.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,283.55
|
|
|
HC HYDRAULIC SWING MINI HI ACTVTY
|
Facility
|
IP
|
$3,863.00
|
|
|
Service Code
|
CPT L5826
|
| Hospital Charge Code |
905355826
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$772.60 |
| Max. Negotiated Rate |
$3,476.70 |
| Rate for Payer: Blue Shield of California EPN |
$2,062.84
|
| Rate for Payer: Cash Price |
$1,738.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,090.40
|
| Rate for Payer: Cigna of CA HMO |
$2,704.10
|
| Rate for Payer: Cigna of CA PPO |
$2,704.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,545.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,545.20
|
| Rate for Payer: Galaxy Health WC |
$3,283.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,317.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,476.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,576.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,471.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$772.60
|
| Rate for Payer: Multiplan Commercial |
$2,897.25
|
| Rate for Payer: Networks By Design Commercial |
$1,931.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,283.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,458.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,274.79
|
|
|
HC HYDROCOIL
|
Facility
|
OP
|
$3,744.00
|
|
| Hospital Charge Code |
909020028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.80 |
| Max. Negotiated Rate |
$3,369.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,182.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,059.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,059.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,709.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,085.41
|
| Rate for Payer: Blue Distinction Transplant |
$2,246.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,808.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,036.74
|
| Rate for Payer: Cash Price |
$1,684.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,995.20
|
| Rate for Payer: Cigna of CA HMO |
$2,620.80
|
| Rate for Payer: Cigna of CA PPO |
$2,620.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,182.40
|
| Rate for Payer: Dignity Health Media |
$3,182.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,182.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,497.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,497.60
|
| Rate for Payer: Galaxy Health WC |
$3,182.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,246.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,369.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,808.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,310.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,497.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,426.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$748.80
|
| Rate for Payer: Multiplan Commercial |
$2,808.00
|
| Rate for Payer: Networks By Design Commercial |
$1,872.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,182.40
|
| Rate for Payer: Riverside University Health System MISP |
$1,497.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,246.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,246.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,872.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,872.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,182.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3,182.40
|
|
|
HC HYDROCOIL
|
Facility
|
IP
|
$3,744.00
|
|
| Hospital Charge Code |
909020028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.80 |
| Max. Negotiated Rate |
$3,369.60 |
| Rate for Payer: Blue Shield of California EPN |
$1,999.30
|
| Rate for Payer: Cash Price |
$1,684.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,995.20
|
| Rate for Payer: Cigna of CA HMO |
$2,620.80
|
| Rate for Payer: Cigna of CA PPO |
$2,620.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,497.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,497.60
|
| Rate for Payer: Galaxy Health WC |
$3,182.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,246.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,369.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,497.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,426.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$748.80
|
| Rate for Payer: Multiplan Commercial |
$2,808.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,182.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,413.73
|
| Rate for Payer: United Healthcare All Other HMO |
$1,380.79
|
| Rate for Payer: United Healthcare HMO Rider |
$1,350.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,235.52
|
|
|
HC HYDROCOIL DETACHMENT CONTROLLE
|
Facility
|
OP
|
$828.00
|
|
| Hospital Charge Code |
909020029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$502.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$703.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$455.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$455.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$400.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$489.18
|
| Rate for Payer: Blue Distinction Transplant |
$496.80
|
| Rate for Payer: Blue Shield of California Commercial |
$520.81
|
| Rate for Payer: Blue Shield of California EPN |
$404.89
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Central Health Plan Commercial |
$662.40
|
| Rate for Payer: Cigna of CA HMO |
$529.92
|
| Rate for Payer: Cigna of CA PPO |
$612.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$703.80
|
| Rate for Payer: Dignity Health Media |
$703.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$331.20
|
| Rate for Payer: Galaxy Health WC |
$703.80
|
| Rate for Payer: Global Benefits Group Commercial |
$496.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$745.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$621.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$552.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
| Rate for Payer: Networks By Design Commercial |
$538.20
|
| Rate for Payer: Prime Health Services Commercial |
$703.80
|
| Rate for Payer: Riverside University Health System MISP |
$331.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$496.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$496.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$414.00
|
| Rate for Payer: United Healthcare All Other HMO |
$414.00
|
| Rate for Payer: United Healthcare HMO Rider |
$414.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$414.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$703.80
|
| Rate for Payer: Vantage Medical Group Senior |
$703.80
|
|
